阵发性心房颤动冷冻消融与射频消融早期复发及其预测因素对比

Early recurrence and predictive factors after pulmonary vein isolation of paroxysmal atrial fibrillation with different ablation technologies: comparison of radiofrequency vs cryoballoon ablation

目的评价阵发性心房颤动(简称房颤)患者采取二代冷冻消融(CB)及射频消融(RF)早期复发的对比及其预测因素。方法入选拟行阵发性房颤消融术的患者160例。分为CB组和RF组,各组80例。比较两组患者临床资料,分别于术前及术后24 h测定炎症因子和心肌损伤标志物。明确两组术后房颤早期复发的危险因素。结果两组性别、年龄、发病时间及左房内径均无差异。CB组与RF组早期复发率无差异(33.8%vs 32.5%,P>0.05)。术前两组炎症因子和心肌损伤标志物无差异。术后CB组心肌损伤标志物肌钙蛋白、肌酸激酶、肌酸激酶同工酶及谷草转氨酶的升高明显高于RF组(P<0.05)。Logistic多因素回归分析示性别、左房内径、术前白介素-6(IL-6)值及术后IL-6值是RF组早期复发的独立危险因素,对于CB组,只有性别是房颤早期复发的独立危险因素(女性患者更高,P<0.05)。结论冷冻消融与射频消融早期复发率无明显差别,并且由于其心肌损伤方式不同,术后预测早期复发因素有所不同。

Objective To assess the early recurrences of atrial tachyarrhythmias and predictive factors in patients with paroxysmal atrial fibrillation(AF) having undergone second-generation cryoballoon ablation(CB) and radiofrequency(RF) ablation. Methods One hundred and sixty consecutive paroxysmal AF patients undergoing pulmonary vein(PV) isolation were enrolled, performed with either a 2 nd-generation CB(CB group) or RF ablation(RF group). Each group had 80 patients. The level of inflammatory factors, myocardial injury markers from the patients at pre-procedure and one day after procedure were measured for assess the predictive factors of early recurrences in two groups. Results There was no significant difference in sex, age, duration time and left atrial diameter between the two groups.The early recurrence rate was 32.5% in the RF group and 33.8% in the CB group. The levels of hypersensitive C-reactive protein(hsCRP),white blood cell(WBC),neutrophil-to-lymphocyte ratio(NLR),monocyte(M),creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),tropinin T(TnT) and glutamic oxalacetic transaminase(GOT) were increased in both groups after procedure.The increase of TnT, CK, CK-MB and GOT in the CB group were significantly higher than those in the RF group(P<0.05). In the logistic regression analysis, we found that gender, left atrial diameter, the baseline level of IL-6 and the post-procedure IL-6 values were independent risk factors for early recurrence(P<0.05) in the RF group. Only gender was independent risk factors for early recurrence in CB group. Conclusions RF catheter ablation and CB ablation of the early recurrence rate is no significant difference. There are different predictive factors in different ablation methods.